EP2147639A1 - Retractor with adjustable valves - Google Patents

Abstract

The retractor has two spreader arms displaced relative to one another and comprising end sections with blades displaced in a gripping region for engaging in a wound. One of the blades is linearly, displaceably accommodated in a linear guide i.e. dovetail guide (12), formed by the spreader arms in such a way that the blade is fixed in different positions, which correspond to different gripping regions, by a detachable fixing device e.g. latching ball (17) and recess (18). The guide is opened on both sides, and the blades comprise a complementary form-fitting profile in a surface section (13).

Description

The invention is in the technical field of surgical instruments and relates, according to its type, to a wound spreader having valves which can be adjusted in their grip areas, according to the preamble of patent claim 1.

Wound spreaders, also called wound sealers, serve to keep a wound open during an operation and to provide the surgeon with free access to the surgical field.

In a typical construction, wound spreaders include two hingedly connected spreader arms ("branches") provided on one side of the joint with spreader arms for engaging a wound and on the other side with actuator arms for operating the retractor. On the spreader arms are generally planar expansion elements ("Valven") attached, which can be hooked to the wound edges. About a manual actuation of the actuating arms, which are usually provided for this purpose with finger engagement eyelets, the two expansion lever can be pivoted and the valves are brought into a selectable relative distance. A releasable latching toothing serves to lock the expansion lever in the respective spread position.

Such wound spreaders are sold in large numbers on the market, for example as Weitlaner's wound spreader (DIN 58249), and have already been described many times in the patent literature.

A disadvantage of wound spreaders is in particular the fact that the valves are often not interchangeable, so that for different uses, for example, depending on the strength of the retained tissue layer, different spreaders must be kept. This is associated with relatively high acquisition costs. In addition, in some cases it is only when inserting the wound spreader into the wound that it is shown which valves are most suitable for keeping the wound open. However, since wound spreaders are usually fitted with valves in a symmetrical manner, even if a wound spreader having shapes and sizes suitable for the wound is inserted into the wound, an unsatisfactory result can be achieved if opposing wound edges are at different anatomical heights , In this case, a different working length of opposing valves is required.

To solve these problems shows that German Patent No. 35 09 787 C2 a surgical instrument for spreading wound edges with Valven their grip range or working length is adjustable. The valves each consist of two mutually displaceable parts, which can be moved and fixed by a spindle mechanism in different relative positions. An adjustment of the grip area via a manual rotation of the spindle with a screwdriver.

A disadvantage of this surgical instrument is especially the two-part design of Valven and their coupling via a spindle mechanism, which causes relatively high manufacturing costs in industrial series production. In addition, the adjustment of the working length of Valven is only cumbersome to accomplish by using a screwdriver, resulting in not inconsiderable time during the operation to complete and may require a helping "third hand". By using a tool to adjust the working length of the valves and the possibility of exerting a relatively large amount of force, there is a risk that the valves may be set too long and undesirably cause tissue damage. In addition, Valven this type are difficult to clean, especially in the area between the two parts of a valve and in the windings of the spindle mechanism impurities can easily settle.

Another major disadvantage of this instrument is that the valves are not replaced, so that only the working length of the valves can be adjusted, but there is no way to vary the shape of the valves, in particular the number of tines.

In contrast, the object of the present invention is to provide a surgical wound spreader, by which the disadvantages of conventional retractors with adjustable in their grip range Valven can be avoided.

These and other objects are achieved according to the proposal of the invention by a Wundspreizer with the features of the independent claim. Advantageous embodiments of the invention are indicated by the features of the subclaims.

A generic wound spreader comprises at least two spreader arms that are adjustable relative to one another. At their end portions, the spreading arms are each provided with adjustable in their gripping areas, sheet-like expansion elements (Valven) for engagement in the wound edges of a wound.

Here and further, the term "gripping area" of a valve is understood to mean that part of a valve which serves to engage the wound edges of a wound and thus extends from the spreading arm to the distal end of the valve, in particular its prong (s). The grip area of a valve corresponds to its (effective) working length in the extension direction.

The retractor according to the invention is now characterized essentially by the fact that at least one of the valves is formed in one piece and is linearly displaceable in its extension direction in a linear guide formed by a spreader arm, so that it is in a plurality (at least two) different by means of a detachable fastening device Positions which correspond to different gripping ranges (ie different working lengths) can be determined optionally. According to the invention can thus advantageously without the need to change the actual Valvenlänge, as is the case with the above-mentioned adjustable two-part Valve, the working length or for engaging in a wound available gripping area changed and adapted to the particular situation ,

In a particularly advantageous embodiment of the inventive retractor, the linear guide is designed in the form of a dovetail guide which is open on both sides in the guide direction, wherein the valve has a complementary fit at least in a section accommodated therein. Dovetail guides offer the particular advantage that the valves received therein tilt under load in such a way that the fixing of the valves in the guide direction is supported by the fastening device.

In a further advantageous embodiment of the inventive retractor, the releasable fastening device has at least one engagement pair, which comprises an engagement means which engages positively and / or positively in an associated recess. Here, the engagement means is connected to a selected from Spreizarm and attached Valve element and on the other element a plurality of recesses are formed for engagement with the engagement means. This advantageously realizes a latching mechanism. The engagement means, which is formed for example in spherical shape, in particular by a spring means in force and / or positive engagement with each one of the recesses, which are for example circular or spherical shell-shaped, brought. Advantageously, the recesses are formed, for example, with an equal spacing on the valves in a row along their extension directions.

The engagement means may for example also be designed in the form of a threaded element which can be brought into each of the recesses in positive and / or positive engagement.

In a preferred embodiment of the invention, the spreader is provided with two articulated spreader levers, each having a spreader arm located on one side of the spine with a valve attached thereto for engagement with a wound and an actuating arm located on the other side of the spine with a finger engagement eyelet have to operate the Wundspreizers.

In a further advantageous embodiment of the invention, the two spreading spreader arms are adjustable by a locking device optionally lockable in an adjustment position.

Fig. 1

in einer perspektivischen Ansicht ein Ausführungsbeispiel des erfindungsgemäßen Wundspreizers;

Fig. 2

in einer weiteren perspektivischen Ansicht einen Spreizarm des Wundspreizers von Fig. 1;

Fig. 3

in einer Schnittansicht den Spreizarm von Fig. 2 gemäß Schnittlinie D-D;

Fig. 4

in einer weiteren Schnittansicht den Spreizarm von Fig. 2 gemäß Schnittlinie G-G von Fig. 3;

Fig. 5

in einer weiteren perspektivischen Ansicht den Wundspreizer von Fig. 1 mit geschlossenen Spreizarmen;

Fig. 6

in einer weiteren perspektivischen Ansicht den Wundspreizer von Fig. 1 mit geöffneten Spreizarmen und Valven mit maximalem Greifbereich;

Fig. 7

in einer weiteren perspektivischen Ansicht den Wundspreizer von Fig. 1 mit geöffneten Spreizarmen und Valven mit minimalem Greifbereich.

The invention will now be explained in more detail with reference to an embodiment, reference being made to the accompanying drawings. Identical or equivalent elements are designated in the drawings by the same reference numerals. Show it:

Fig. 1

in a perspective view of an embodiment of the invention Wundspreizers;

Fig. 2

in a further perspective view of a spreading arm of the wound spreader of Fig. 1 ;

Fig. 3

in a sectional view of the Spreizarm of Fig. 2 according to section line DD;

Fig. 4

in a further sectional view of the Spreizarm of Fig. 2 according to section line GG of Fig. 3 ;

Fig. 5

in a further perspective view of the wound spreader of Fig. 1 with closed spreader arms;

Fig. 6

in a further perspective view of the wound spreader of Fig. 1 with open spreader arms and valves with maximum gripping area;

Fig. 7

in a further perspective view of the wound spreader of Fig. 1 with open spreader arms and valves with minimal gripping area.

With reference to Fig. 1 to Fig. 4 An exemplary embodiment of a wound spreader according to the invention which is designated overall by the reference numeral 1 will now be described.

Accordingly, the wound spreader 1 comprises two spreading levers 2, which are articulated to one another approximately in the middle thereof via a hinge joint 3. Each of the two expansion levers 2 comprises a spreading arm 4 located on one side of the hinge joint 3 and an actuating arm 5 located on the other side of the hinge joint 3. The end sections of the two actuating arms 5 are each provided with finger engagement eyes 6 which serve to open the spreading levers 2 to move manually and to bring the spreading arms 4 in different pivoting or spreading positions.

About a designed in the form of a latching locking device, the expansion lever 2 in an optional pivotal position in which the two valves 9 assume a desired relative distance from each other, are locked. The latching toothing comprises an arc-shaped lug 7 attached to one of the two actuating arms and having a toothing 8 extending along the arc and an in Fig. 1 concealed Kinke, which is held by a spring 20 in engagement with the toothing 8. The Kinke is formed on a finger lever 11 which is articulated to the other actuating arm by means of a hinge pin 10. The teeth of the toothing 8 are shaped so that the Kinke can slide in the manner of a ratchet mechanism when merging the two finger engagement eyelets 6 via the teeth 8, but hooked in the tooth gaps in the reverse direction of movement and thus blocks a merging of the spreading arms 4. By pressing the finger lever 11 against the spring force of the Kinke in engagement with the toothing 8 holding spring, the locking mechanism can be solved be to guide the two spreading arms 4 to each other.

At the end portions of the two spreading arms 4 each integral Valve 9 are mounted to engage in opposite wound edges. The Valven 9 each consist of a flat surface portion 13 and extending in the direction of extension of the valves 9 from the surface portion 13 curved tines 14. The valves 9 are slidably mounted in the extension direction at the end portions of the two spreading arms 4 and for this purpose each with its surface portion 13 in a taken at the end portions of the spreader 4 shaped dovetail guide 12. Each dovetail guide 12 is shaped in cross-section to the direction of extension of the valve 9 in the manner of a dovetail, d. H. it comprises an approximately flush with the direction of extension of the end portion of the associated Spreizarms 4 arranged base surface 15 and two at an acute angle (angle less than 90 °) to the base surface 15 employees employed, conically converging side surfaces 16 which surrounds the valve 9 received therein from three sides , The two dovetail guides 12 are in this case arranged so that they taper conically towards the other dovetail guide 12. The valves 9 have in the region of the surface portion 13 a complementary fit to the dovetail guide 12, wherein the surface portions 13 of the base surface 15 abut. The dovetail guides 12 allow the valves 9 to be linearly displaced along their directions of extension and fix the valves 9 in the other directions.

A fixation of Valven 9 takes place in each case by a latching mechanism which comprises a received within the dovetail guide 12 in a ball seat 19 detent ball 17, by the spring force of the spring means 21 into engagement with a surface portion 13 shaped recess 18 of the valve 9 is brought. The surface portions 13 of each valve 9 are each provided for this purpose with a plurality of recesses 18 which are arranged distributed in the extension direction of the valve 9 with an approximately equal spacing between them. The spherical shell-shaped recesses 18 have a corresponding fit to the detent ball 17. The detent ball 17 and a recess 18 located in engagement with the detent ball 17 together form an engagement pair.

By the latching mechanism, each valve 9 can be fixed in different locking positions corresponding to the respectively engaged engagement pair along the direction of extension within the dovetail guide 12. By changing the detent position in this case the gripping area or the working length of a valve 9, which is given by the distance of the distal end of the valve 9 (or their prongs 14) from the associated Spreizarm 4 can be adjusted. As a result of the dovetail guides 12, which are open on both sides in the extension direction, the valves 9 can project from the dovetail guide 12 into locking positions with a gripping area shortened in relation to the maximum gripping area. An adjustment of Valven 9 within the dovetail guides 12 is done manually, the locking mechanism on the one hand ensures good displacement and on the other hand, a secure fit. When the wound spreader 1 is brought into working position, a force is exerted on the valves 9 by the wound edges, through which the valves 9 are loaded in the direction of one another. This has in a particularly advantageous manner, a tilting of the valves 9 in the dovetail guides 12 result, by which the fixation of the valve 9 is supported.

In the figures, the Valve 9 are exemplary with seven with a respective same spacing in one Row along the displacement or extension direction of Valven 9 arranged recesses 18 (corresponding to seven different locking stages) provided. Only the completeness should be noted that a larger or smaller number of click stops is possible.

It would also be conceivable that, instead of a spring-loaded detent ball 17, a manually adjustable screw is provided, which can be brought into each case in non-positive and / or positive engagement with the recesses 18 formed in the surface portion 13.

In the Fig. 5 to 7 Different positions of the two expansion lever 2 are shown. Fig. 5 shows a situation in which the two spreading arms 4 touch each other, corresponding to a maximum distance of the two finger grommets 6. In Fig. 6 the two spreading arms 4 have been brought by bringing the Fingereinriffsösen 6 in a maximum spread position. The slightly salvaged in the extension direction Valven 9 here have a maximum working length (maximum gripping area), ie the detent ball 17 engages in the recess 18 which is the furthest spaced from the tines 14. In contrast, shows Fig. 7 a situation in which the two Valven 9 have a minimum working length (minimum gripping area), ie the detent ball 17 engages in the recess 18 which has the smallest distance to the tines 14. According to the different latching steps, the working length of the integral valve 9 can be varied between the minimum and maximum working length. Although this is not shown in the figures, it is also possible for the two valves 9 to be set, optionally, to different working lengths from each other, in particular to use the wound spreader 1 in wounds having wound edges located at different anatomical heights.

Due to the dovetail guides 12, which are open on both sides in the guide direction, the valves 9 can be exchanged very easily in order to use different sized or differently shaped valves, depending on the intended use. In Fig. 1 are shown by way of example further Valve 9 ', 9 ", which differ in the number of their tines.

LIST OF REFERENCE NUMBERS

1

retractors

2

spreading lever

3

hinge

4

spreading arm

5

actuating arm

6

Fingereingriffsöse

7

flap

8th

Perforation

9, 9 ', 9 "

Valve

10

pintle

11

finger lever

12

dovetail guide

13

surface section

14

prong

15

footprint

16

side surface

17

detent ball

18

recess

19

ball seat

20

feather

21

spring means

Claims (10)

Wound spreader (1) having at least two spreader arms (4) which are adjustable relative to each other and are provided at their end portions in each case with adjustable in their gripping areas Valven (9) for engaging in a wound, characterized in that at least one of the valves (9) is integrally formed and in one of a Spreizarm (4) shaped linear guide (12) is linearly slidably received so that they can be fixed by means of a releasable fastening means (17, 18) in a plurality of different positions, each corresponding to different gripping areas, optional. A wound spreader (1) according to claim 1, characterized in that the linear guide is designed in particular in the form of a dovetail guide (12) open on both sides in the guide direction and the valve (9) has a complementary fit at least in a section (13) received therein. Wound spreader (1) according to one of claims 1 to 2, characterized in that the releasable fastening device has at least one engagement pair (17, 18), which comprises a force-locking and / or positive engagement in a recess (18) engaging means (17), wherein the engagement means (17) is connected to an element selected from the spreader arm (4) and the associated valve (9) and a plurality of recesses (18) are formed on the respective other element for engagement with the engagement means. Wound spreader (1) according to claim 3, characterized in that the releasable fastening means (17, 18) forms a latching mechanism. Wound spreader (1) according to claim 4, characterized in that the engagement means (17) is brought by a spring means in non-positive and / or positive engagement with one of the plurality of recesses (18). Wound spreader (1) according to claim 5, characterized in that the engagement means (17) are spherical and the recesses (18) are each formed in a circular or spherical shell shape. Wound spreader (1) according to one of claims 3 to 6, characterized in that the recesses (18) on the valves (9) are arranged in rows along their extension directions. Wound spreader (1) according to claim 3, characterized in that the engagement means (17) in the form of one with each of the recesses (18) in force and / or positive engagement engageable threaded member is formed. A wound spreader (1) according to any one of claims 1 to 8, provided with two articulated spreader levers (2), each having a spreader arm (4) with valve (9) attached thereto on one side of the articulation (3) in a wound and on the other side of the joint (3) located actuating arm (5) with finger engagement eye (6) for actuating the Wundspreizers have. Wound spreader (1) according to claim 9, characterized in that the expansion levers (2) can be locked by a particularly releasable locking device (7, 8).

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